Guimarães Michele Mf, El Dib Regina, Smith Andrew F, Matos Delcio
Department of Aesthetics and Cosmetology, Center of Maringa Higher Education (CESUMAR), Guedner Avenue 1610, Maringá, Paraná, Brazil.
Cochrane Database Syst Rev. 2009 Jul 8(3):CD006058. doi: 10.1002/14651858.CD006058.pub2.
Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry (IS) compared to no therapy, or physiotherapy including coughing and deep breathing, on all-cause postoperative pulmonary complications and mortality in adult patients admitted for upper abdominal surgery.
To assess the effects of incentive spirometry compared to no such therapy (or other therapy) on all-cause postoperative pulmonary complications (atelectasis, acute respiratory inadequacy) and mortality in adult patients admitted for upper abdominal surgery.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 3), MEDLINE, EMBASE, and LILACS (from inception to July 2006). There were no language restrictions.
We included randomized controlled trials of incentive spirometry in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.
Two authors independently assessed trial quality and extracted data.
We included 11 studies with a total of 1754 participants. Many trials were of only moderate methodological quality and did not report on compliance with the prescribed therapy. Data from only 1160 patients could be included in the meta-analysis. Three trials (120 patients) compared the effects of incentive spirometry with no respiratory treatment. Two trials (194 patients) compared incentive spirometry with deep breathing exercises. Two trials (946 patients) compared incentive spirometry with other chest physiotherapy. All showed no evidence of a statistically significant effect of incentive spirometry. There was no evidence that incentive spirometry is effective in the prevention of pulmonary complications.
AUTHORS' CONCLUSIONS: We found no evidence regarding the effectiveness of the use of incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.
上腹部外科手术与术后肺部并发症的高风险相关。通过合理运用增加肺容量的治疗手段，可以降低术后肺部并发症的风险和严重程度。我们的目的是评估激励肺活量测定法（IS）与不进行治疗或与包括咳嗽和深呼吸在内的物理治疗相比，对接受上腹部手术的成年患者全因术后肺部并发症和死亡率的影响。
评估与不进行此类治疗（或其他治疗）相比，激励肺活量测定法对接受上腹部手术的成年患者全因术后肺部并发症（肺不张、急性呼吸功能不全）和死亡率的影响。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2006年第3期）、MEDLINE、EMBASE和LILACS（从创刊至2006年7月）。没有语言限制。
我们纳入了对接受任何类型上腹部手术的成年患者进行激励肺活量测定法的随机对照试验，包括接受腹腔镜手术的患者。
两位作者独立评估试验质量并提取数据。
我们纳入了11项研究，共1754名参与者。许多试验的方法学质量仅为中等，且未报告对规定治疗的依从性。荟萃分析仅能纳入1160名患者的数据。三项试验（120名患者）比较了激励肺活量测定法与无呼吸治疗的效果。两项试验（194名患者）比较了激励肺活量测定法与深呼吸练习的效果。两项试验（946名患者）比较了激励肺活量测定法与其他胸部物理治疗的效果。所有试验均未显示激励肺活量测定法有统计学显著效果的证据。没有证据表明激励肺活量测定法在预防肺部并发症方面有效。
我们没有找到关于使用激励肺活量测定法预防上腹部手术术后肺部并发症有效性的证据。本综述强调了在该领域进行精心设计试验的迫切需求。有必要开展方法学严谨的大型随机试验，以确定使用激励肺活量测定法在死亡率方面的任何益处。
